INTRODUCTION

Under the supervision of the Medical Billing Coding Manager, the coding specialist is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding specialist also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

DUTIES AND RESPONSIBILITIES

• Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Supports the Senior Medical Billing and Coding Specialist to respond to audit findings and make applicable coding additions or corrections.
• Registers and analyzes claims in the EMR system, including insurance verification and charge entry. Tracks and requests outstanding claims for assigned departments/facilities.
• Reviews Medicare Local Coverage Determination (LCDs) and Medicare bulletin updates.
• Utilizes the EMR system to run required daily/monthly/quarterly reports on claims entered.
• Accepts assignments from management and maintain open communication with their manager to resolve quality and production issues.
• Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third-party reimbursement agencies and special screening criteria.
• Complies with the rules and regulations of Medicare billing including (but not limited to) incident to, teaching situations, shared visits, consultations, and global surgery.
• Efficiently and accurately processes all types of claims utilizing broad based product or system knowledge to ensure timely payments are generated.
• Maintains strict confidentiality regarding confidential conversations, documents, and files.
• Supports the Senior Medical Billing and Coding Specialist to facilitates coding orientation for new providers.
• Ability to read and abstract physician office notes and procedure notes to apply correct ICD-10-CM, CPT, HCPCS Level II and modifier coding assignments. Perform audits when necessary.
• Performs other duties as assigned.

QUALIFICATIONS

• High School diploma or GED required/associate’s degree preferred.
• Minimum of 5 years’ coding experience using ICD-10-CM, Volumes 1- 3, CPT, HCPCS, and IHS coding conventions.
• Coding certification is required through AAPC or AHIMA

KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION

• Complete knowledge and understanding of PM and EMR workflows.
• Must demonstrate ability to work independently with minimum supervision in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
• Advanced knowledge of medical codes involving selections of most accurate and description code using the extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Excellent oral, written, and telephone communication.
• Working familiarity with the rules and regulation pertaining to the government/private/FQHC guidelines.
• Ability to prioritize and manage multiple task with efficiency in dealing with multiple facilities.
• Ability to handle a large volume of project receiving and researching claims.
• Excellent computer skills, including Excel, Microsoft Word, etc.

SUPERVISORY CONTROLS

This position reports directly to the Coding Manager.

GUIDELINES

This position abides by all rules and regulations set forth by applicable licensing and regulatory bodies, as well as UHC policies and procedures.

PERSONAL CONTACTS

This position has primary contact with the clients and employees of Unity Health Care.

PHYSICAL DEMANDS

Refer to attached ADA requirements for the position.

WORK ENVIRONMENT

Refer to attached ADA requirements for the position.

OTHER SIGNIFICANT FACTS

Hours may include some evenings and/or Saturday work. While every effort is made to assign staff to one clinic site regularly, Unity may change the assigned clinic and/or site temporarily or permanently, depending upon the need.

RISKS

The position works involves everyday risk and discomforts, which require normal safety pre-caution typical of such places as offices, meetings, training room and other UHC health Care Sites. The work area is adequately lit, heated and ventilated. The position requires contact with staff at all levels throughout the organization. There are also external organization relationships that may be a part of the work of this individual. All medical services shall be provided according to medical accepted community standards of care. Shall provide evidence of recent (within the past twelve (12) months) health assessment that includes a PPD and/or chest x-ray results. Shall provide evidence of vaccination for Hepatitis A & B.

The statements contained herein describe the scope of the responsibility and essential functions of this position, but should not be considered to be an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other areas to cover absences or relief to equalize peak work periods or otherwise balance the workload.